Biomedical subjects
W G Maxymiw
Publications and source records attributed to W G Maxymiw.
Re: 'Comments by Dr. McComb'.
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'Surprised' by several comments.
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The role of dentistry in patients undergoing bone marrow transplantation.
It is imperative that a comprehensive dental examination should be performed in all patients who are to undergo a bone marrow transplantation. Such assessments should be carried out prior to and after the transplantation procedure. This paper addresses the implications of marrow transplantation and the impact on dental treatment. The side-effects of transplantation chemotherapy, radiation treatment and graft versus host disease and their impact on the oral cavity are also discussed in this paper.
The immediate role of the dentist in the maxillectomy patient.
It is imperative that comprehensive planning takes place for the potential maxillectomy patient. Input from the dentist is required for all stages of the procedure, from initial consultation to placement of the final prosthesis. By utilizing an interim dental prosthesis (splint), the impact of tissue loss, wound fibrosis and neurological damage can be minimized. In this paper, the authors address the initial stage in the treatment sequence, the surgical splint.
The role of dentistry in head and neck radiation therapy.
In the adult patient, oral complications of cancer radiotherapy stem from the deleterious effects of radiation on salivary glands, oral mucosa, mandibular musculature and alveolar bone. Clinical consequences of such treatment include xerostomia, rampant dental decay, mucositis, taste loss, osteoradionecrosis, infection, trismus, and nutritional stomatitis. These alterations to the normal state occur both during and after completion of head and neck radiation. Fig. 1 outlines the time frame involved in the development of each particular problem. In the past 20 years, many changes have occurred in the management of patients receiving radiation therapy. The traditional regimen of dental care in these patients was one of extracting all teeth encompassed by the radiation field. However, 15 years ago, this concept was questioned due to the incidence of post radiation caries (PRC) outside the zone of irradiation. The purpose of this paper is to review the major consequences of radiation treatment to the head and neck as well as outline the role of the dentist in the management of these patients.
Maxillo-facial tumors.
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The utilization of a multi-layer prosthesis to treat recurrent antral carcinoma: a case report and review of the literature.
This paper reviews the use of an intracavitary mold in the radiotherapeutic management of recurrent sub-orbital carcinoma of the maxillary sinus. An overview of the clinical features of antral carcinomas and the concept of brachytherapy in the management of these lesions is presented. Brachytherapy is usually reserved for relatively accessible lesions. Post-surgical and radiation-induced trismus can be a complicating factor, as in the case presented, where the inter-incisal distance was less than three millimeters. To circumvent the problem, a multi-layer antral plug was utilized as a carrier for the radioactive sources, and its construction is described.
A clinical comparison of glass ionomer, resin-modified glass ionomer and resin composite restorations in the treatment of cervical caries in xerostomic head and neck radiation patients.
Controversy exists as to whether there is less secondary caries at the margins of glass ionomer restorations compared with other materials that do not release fluoride. This study examined the incidence of secondary caries for three types of restorative materials in Class V restorations in xerostomic patients. The study group consisted of 45 high caries-risk adult patients who had undergone head and neck irradiation for the treatment of cancer. All were substantially xerostomic and in need of at least three restorations in the same arch. Every patient received a restoration with each of the test materials, a conventional glass ionomer (GI), a resin modified glass ionomer (RMGI) and a resin composite (C). Patients were instructed in the daily use of a neutral pH sodium fluoride gel in custom trays. Recall appointments were made at 6, 12, 18 and 24 months, and the restorations were examined for material loss, marginal integrity and recurrent caries at the restoration margin. Fluoride compliance was determined at each recall period and recorded as the percentage of recommended use during that interval. Patients were categorized at the end of the study as fluoride non-users if their average compliance was 50% or less. Those with greater than 50% compliance were categorized as fluoride users. In the latter group, no recurrent caries was found for any of the restorations, whereas a material-dependent incidence of recurrent caries was found in the fluoride non-user group. None of the GI, one RMGI and eight C restorations failed due to recurrent caries. For the fluoride non-user patients, Fishers exact test (p=0.05) showed no statistical difference between GI and RMGI but statistical differences were found among those materials and resin composite at each recall period. Recurrent caries reductions for GI and RMGI relative to C were greater than 80% in xerostomic patients not using topical fluoride supplementation.
A clinical comparison of glass ionomer (polyalkenoate) and silver amalgam restorations in the treatment of Class 5 caries in xerostomic head and neck cancer patients.
Fifty-four pairs of restorations (one glass ionomer and the other amalgam) were placed in the mouths of 36 xerostomic head and neck cancer patients. Patients were either fluoride users or fluoride nonusers. In patients who used a daily application of a mildly acidic (pH 5.8) sodium fluoride gel, glass-ionomer cements failed and amalgam restorations did not (P < 0.0001). In patients who neglected to use their topical fluoride as directed, glass-ionomer cement restorations did not fail, but amalgam restorations did (P < 0.001). The mean time to restoration loss for both restorative materials was 8.5 months. In severely xerostomic patients these findings were exaggerated.